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Name of circle AP
Date: 14.11.2014.
Sr DESCRIPTION
.
REMARKS
2
Number of Connections taken*
*details of mobile numbers to be attached as per Annexure I
Customer undertaking
I/We hereby confirm that we are using the Airtel Mobile connections and the user name along with their
designation is provided against these mobile numbers as per the annexure1 containing ________pages.
I will update you on any name change happening in future due to transfer of mobile numbers, within a week
of any such change.
________________________________________________________________
Customer Signature (Authorized signatory)
________________________________________________________________
Company Stamp
Sr DESCRIPTION
.
REMARKS
1
2
3
4
14.11.2014
1. I/We hereby confirm that I am / we are not using Airtel telecom facilities for running the application
services like tele-calling, tele-marketing, tele-medicine, tele-education, tele-trading, e-commerce,
domestic call centre, international call centre, network operation centre etc., which fall under OSP
registration/ License with DOT.
My / our OSP / Telemarketing Registration number is ... (Applicable only in
case of using Airtel telecom facilities for the above mentioned applications).
2. I/We confirm and undertake that the SIM provided to me is non-transferable and it shall not be further
assigned or on any other commercial basis to any unauthorized person. Further, I/We further undertake
that I/we shall be personally responsible for any misuse of the SIMs allocated to me/us and also liable
for proceedings that may be initiated by any of the Agencies of Government/DoT for any acts deeds &
things that may be done / caused to be done or alleged to have been caused or done by me/us from
the above mobile numbers and we will keep Bharti Airtel Limited indemnified against any such
proceedings.
3. I/We hereby confirm that any change in the user of mobile numbers, currently used by me / us shall be
duly informed within 7 [seven] days of any such change.
______________________________________________________________
Customer Signature (Stamp in case of Company)
_____________________________________________________________
Verifiers name and signature
________________________________________________________________
External agency/Verifying agency stamp
Bharti Airtel Limited <Name of Person>/<External Agency representative visiting the premises>
In case of any suspicion about the nature of business carried out / observed, the same has to be
brought to the knowledge of the following officers immediately along with complete details.
[1] Zonal Business Manager/ CSD AV Compliance Representative
[2] Regulatory / Legal Department
Annexure I
Sr.
No
1
Mobile
Number
8790855499
Company User
name
D SAJITH
2
3
8374277222
8374377222
4
5
6
9963004222
8008774333
8374075999
7
8
9
10
8374065999
9177199992
9618505222
8790545888
K VINAY KUMAR
G
VENKATARAMANA
V UPENDRA
T RATNKAR
S SATYA
SOMESWARI
P PRASAD
P VIJAYA KUMAR
P GAGAN
N KRISHNA
USER
DESIGNATION
BRANCH
MANAGER
ASST MANAGER
ACCOUNTS
EXECUTIVE
SR. EXECUTIVE
SR. EXECUTIVE
EXECUTIVE
EXECUTIVE
EXECUTIVE
EXECUTIVE
ASSISTANT